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Dust a Cold Warrior's plague

National Jewish sleuth tracks beryllium illness catching metal workers, others unaware of risks

By Lisa Ryckman
Denver Rocky Mountain News Staff Writer


For 14 years, Beverly Lutz worked in Building 444 at Rocky Flats, confident she was safe.

Behind the door of 444, foot soldiers of the Cold War made nuclear weapon parts out of the non-radioactive metal beryllium: lighter than aluminum, stronger than steel and safer than plutonium — or so they thought.

Decades before, people had gotten lung disease from inhaling huge amounts of beryllium dust. But after the government put strict limits on exposure, the illness seemed to disappear.

The people who worked with the metal every day at Rocky Flats thought they were safe.

So did Beverly Lutz, who spent 32 years at the nuclear weapons plant as a secretary.

She'd never touched beryllium in her life.

-

Lee Newman came to Denver because he considered it the best place in the world to learn to be a lung doctor.

At the turn of the 20th Century, National Jewish Hospital and the Denver Sheltering Home cared for victims of tuberculosis, a chronic lung disease that thrived on poverty and spread with a cough.

In 1978, five years before Newman arrived, the two institutions merged to become what is now National Jewish Medical and Research Center, the largest U.S. medical center devoted to the study and treatment of chronic respiratory diseases and immune system disorders.

As a medical student, Newman had been drawn to pulmonology — the study of the lungs — by emotion. "I felt really sorry for people who couldn't breathe," he says. "I wanted to help them."

He took a roundabout route into medicine. The New Jersey-born son of a art teacher and a retailer, Newman was still a teen-ager when he started a successful business with his brother making and marketing translucent plastic jewelry.

Eventually, Newman, along with his brother and mother, wrote a series of crafts books, how-tos on everything from lamps to frames to kites — his personal passion. He worked as a reporter in college, then earned a master's degree in social psychology before heading to medical school.

Workplace disease attracted him because of his desire to prevent illness, not just treat it.

In the library at National Jewish, Newman decided on a research topic: he would expose mice to beryllium dust to try to better understand how the immune system reacts to metals that cause disease.

Beryllium, found in beryl and betrandite rock, is at once strong and lightweight, non-magnetic and a good conductor of heat and electricity: the perfect metal for making nuclear weapons.

Newman thought that decades-old government limits on beryllium exposure had virtually eliminated chronic beryllium disease, also known as CBD or berylliosis. But the research would help him understand the immune mechanism behind a fairly common lung disease, sarcoidosis.

Not long after Newman began his work, the medical director at Rocky Flats called with a question: he needed to move a pregnant woman out of the plutonium area because of the radiation danger. Would it be safe to expose her to beryllium?

"And we said, 'Beryllium? You have beryllium at Rocky Flats?' That's how little we knew at the time," Newman says. "Here I am, working at a research lab studying beryllium, 17 miles from the place where 60 percent of the beryllium in the Western world is being used, and I don't even know it."

-

Think of a war between the body's immune system and invading particles of beryllium, and the nature of CBD becomes clear.

"The lungs happen to be the battlefield," Newman says. "And by the end of the battle, the battlefield is trashed."

Most people can inhale beryllium dust or fumes without becoming ill. But 2 to 6 percent of the population are allergic, triggering an immune response.

The body's efforts to surround and attack the beryllium particles causes scarring in the lungs that makes breathing difficult. The disease can take years to appear, and then it can be slow-moving but progressive: at first, the person might have trouble breathing during exercise. Eventually, they can't get enough oxygen when they're sitting still.

Debilitating as it is, CBD alone rarely kills, Newman says. But there is no cure. The treatment is the steroid prednisone in the early stages, with oxygen later.

Newman estimates that about 45 percent of the general population have a gene that puts them at higher risk, but people without that gene can still get the disease.

The key is exposure: without it, there is no berylliosis.

By the time Rocky Flats is closed, Newman believes there will be more than 300 people with CBD or sensitization, which often leads to the illness.

"The single most well-recognized and common work-related disease of Cold War veterans is beryllium disease," Newman says.

For these workers, it was the unexpected price of patriotism.

Now people with beryllium disease are cropping up at all of the nation's weapons complexes: Hanford, Wash.; Oak Ridge, Tenn.; Savannah River, S.C.; Los Alamos, New Mexico.

They are being screened with the test that Newman refined, one that he and his colleague Kathleen Kreiss took to Rocky Flats in 1985. They wanted to do a pilot study to determine the effect of beryllium exposure.

Their proposal brought together 80 people from companies and agencies with a stake in the outcome: Rocky Flats; its then-parent Rockwell International; Brush Wellman Inc., the main manufacturer of beryllium; and the U.S. Department of Energy.

"We were presenting this proposal looking for some funding from the DOE," Newman says. "In point of fact, we were rebuffed by them."

But the head of health and safety at Rocky Flats came down on Newman's side.

"It was his responsibility, it was on his watch," Newman recalls. "He basically ignored the advice he was getting from others and said, 'I'm going with you guys."'

In the end, Rockwell International funded the first study, which screened 50 beryllium machinists. Ten percent of that group were sensitized. The next question: was it possible they already had the disease and didn't know it?

Workers volunteered or a bronchoscopy, a procedure that involved taking small samples of their lung tissue.

"And lo and behold, what we found was, not only was that 10 percent sensitized, but most of them already had beryllium disease," Newman says. "That was an eye-opener. That was the watershed."

On the strength of that small study, Newman obtained $2 million from the National Institutes of Health to screen 900 Rocky Flats workers and begin looking at other companies around the nation.

The kind of job the worker did made a difference, the doctors discovered. Their level of beryllium exposure in that job made a difference. Many of the people who had disease had no symptoms at all. Others had symptoms that had been blamed on other ailments: the unexplained cough, shortness of breath, fatigue, weight loss, fevers and rash was emphysema if the patient smoked; if they didn't, it was asthma.

"Most doctors in this country have never seen a case of beryllium disease," Newman says. "So it's not even on their radar."

-

Margaret Simon was told she had a sinus problem. But treatment didn't help the coughing and the constant feeling that she couldn't catch her breath.

Another doctor said it was allergies, but the allergy shots didn't work. They thought it might be cancer, but it wasn't. Then she was diagnosed with sarcoidosis, a common lung disease caused by scarring of the lung tissue.

Simon took prednisone, which seemed to help. But within a month of going off the drug, the cough was back.

"Then the doctor found out I had worked with beryllium," Simon said.

He sent her to National Jewish to see the head of the Division of Environmental and Occupational Health Sciences — Lee Newman. He diagnosed her illness.

Newman has had to tell many people that they have CBD; delivering bad news is part of the job. He has done it hundreds of times, and it's only getting harder.

"I admit to getting angry, and I get particularly angry when I see patients getting disease from exposures occurring today, which in my mind is inexcusable," Newman says. "Beryllium disease in this day and age should be preventable in the workplace, and yet we're not preventing it."

Simon, 54, never worked in a weapons complex. She is a dental technician — a member of what Newman refers to as a new epidemic wave of CBD sufferers who only now are realizing the danger of working with alloys, mixtures of metals such as copper, magnesium or aluminum that contain as little as 2 percent beryllium.

"They have been told and they believe that a little bit of beryllium is safe, that if you work with alloys, it's safe," Newman says. "And in fact, that's not true."

Bridges and crowns made of beryllium alloys don't cause disease in dental patients; Simon became ill by inhaling the dust created by grindinging and polishing them.

The lab was typical: two rooms in a small house, 10 technicians, minimal protection. Most of the nation's estimated 47,000 dental techs work in small mom-and-pop shops, ones that never get visits from the federal Occupational Safety and Health Administration to ensure compliance with limits on beryllium exposure.

In Simon's former lab, they worked in a cloud of dust and fumes so heavy that the owner was able to extract $7,000 in metal from the carpeting when he replaced it.

"She got into this job because we thought it was clean and safe," said her husband, Vaughn. "It turned out it was neither of those things."

-

Crush a piece of beryllium the size of a pea, then sprinkle the dust in a room one mile square and six feet deep. That is the amount of beryllium exposure the federal government considers acceptable during a work day.

It is an amount that can still cause disease.

The standards were set 50 years ago in response to cases of acute beryllium poisoning caused by exposure to large amounts of the metal's dust and fumes. With the limits in place, beryllium disease seemed to disappear.

An illusion — one Newman has shattered with his research.

"We're seeing disease occurring at levels one-tenth of the current government standards," he says.

Newman fiddles with a keychain made by Brush Wellman, the Cleveland, Ohio-based company that produces much of the beryllium used in the United States.

"What metal would you say this is?" he asks. The medallion dangling from the chain looks like copper, but it also contains 2 to 5 percent beryllium.

"If you were to take some Scotchbrite from your kitchen sink and start shining it up, you would be creating a plume of particles that are going into your lungs, that are just the right size to get into your deep lung, where your immune system could potentially react," Newman says.

Many of the people Newman screens have no symptoms: that's the point of medical screening programs like his.

"There are treatments, and early detection allows you to treat at an earlier stage, before they have to go on a bottle of oxygen," Newman says.

The doctor is in the fifth year of a study of 70 people who were beryllium sensitized but had no signs of the disease. The work has uncovered another piece of the beryllium disease puzzle.

"What we have found is, sensitivation converts to disease at a rate of approximately 10 percent per year," Newman says.

That means that after five years, half of those sensitized have gone on to develop the lung scars that characterize CBD.

In some plants, everyone Newman screens not only tests positive for beryllium sensitization but already has the disease.

Some of those people have mild cases that don't require steroids or oxygen; after five years, 25 percent of those people will need treatment.

The incredible toxicity of beryllium means that the best way to prevent all disease is to stop using it, Newman says. Substitute some other metal to make golf clubs and bicycles and toasters and dental bridges.

There is only one industry that must use beryllium.

"If you felt like you had to make a nuclear weapon," Newman says, "there is no substitute."

-

The e-mail landed in Newman's computer from exactly half a world away, a plea for help from an area near the Chinese border in northeast Kazakhstan.

It is the only place on earth where they see more people with beryllium disease than Lee Newman does at National Jewish.

The message came from a doctor who had heard of Newman's research and wondered if he could help them develop a blood-testing program for Ust-Kamenogorsk, an entire city contaminated with beryllium.

The Ulbinsky metallurgical plant there is the Soviet-era equivalent of Rocky Flats, and the workers have carried the toxic residue of those weapons to their homes. Samples of beryllium have been found on the paths leaving the plant, on the tram, on the steps of the apartment building, on the pillow in the bedroom.

"They've got close to 800 workers with this disease at that one plant, and they've carried it out to their community," Newman says.

Through the years, workers at the beryllium factory were exposed to levels 100 times the acceptable U.S. standard. The result was every known ailment associated with beryllium, including lung cancer.

A 1974 study showed that 4 percent of Ust-Kamenogorsk's general population had been sensitized to beryllium; it was measured in children's hair and mothers' milk. Airborne levels of beryllium were so high that people living 5 kilometers from the plant were being exposed to what the U.S. Environmental Protection Agency's highest acceptable level.

Then in 1990, an explosion and fire at the Ulbinsky factory sent a plume of beryllium dust wafting over the city and beyond. More than 120,000 were exposed to the metal's dust and fumes.

A year ago, Newman and an epidemiologist arrived to see if they could design a surveillance program. Clean-up is too expensive for this impoverished region; exposure is inevitable.

"So for them, probably the major remedies are being able to figure out who's got the disease, and get them treatment," says Newman, who is looking for funding to help the city.

Treatment is problematic. Availability of prednisone is very limited, and oxygen therapy is unheard of. But the need is urgent, because the younger the person with CBD, the more aggressive the treatment must be.

And in Ust-Kamenogorsk, there are children allergic to beryllium.

"That 5-year-old has another 80 years' opportunity to have very severe lung injury. I would consider them at high risk for losing their lungs," Newman says. "And you can't live without them."

-

Cases of beryllium disease arrive on Newman's doorstep every day, and more of them are coming from industries that have nothing to do with nuclear bombs.

"We're just seeing a kind of wake-up call today," the doctor says. "The aerospace industry is just barely waking up to the hazard. The metal machining industry is just barely waking up to the hazard. Metal reclamation plants are just barely waking up to the hazard. The dental technicians are just waking up to the hazard."

Margaret Simon still works as a dental tech; her current employer does not use beryllium. Her co-workers all know she suffers from CBD, but for Simon, berylliosis is a very lonely disease. She doesn't know anyone else who has it.

"Not a soul," she says.

But Newman predicts that will change, unless workers and their employers acknowledge and deal with the danger. A grass-roots movement to educate and protect workers has emerged among people with CBD, fueled by the relief of finally being properly diagnosed and the anger that often follows.

"They're angry because they got exposed to something at work that they didn't know was hazardous," Newman says. "As many of them have said to me, 'If I had known about beryllium, I would have worried more about beryllium than plutonium.' Beryllium was more insidious."

Behind the door of Building 444, Beverly Lutz worked in an office as the superintendent's secretary. When she had to walk through the beryllium shop, she would don a smock and booties — all the protection anyone thought she needed.

Sixteen years after Lutz left 444, she became one of Lee Newman's patients.

"I was never told there was any possibility of me contracting any type of illness from being in that building," she says. "Now that I look back, I had a lot of health problems."

Like others with beryllium disease, Lutz found herself struggling with both an incurable illness and an intractable company.

"I just felt real disappointment that I had to resort to hiring an attorney to go through the worker's comp process because the company was not willing to admit liability," Lutz says. "They said I had to prove I contracted it there. Well, I worked there from the time I was 18 years old. I never worked anywhere else. Where else would I get it?"

Newman's revelations about the toxic nature of beryllium — and the minute amounts needed to cause disease — have been the catalyst for an effort to change government policy. The Energy Department recently decided to honor the health claims of Cold War weapons workers, a plan yet to be approved by Congress.

The concept began with compensation for victims of berylliosis; recently it was expanded to include everyone who became ill producing the nation's nuclear weapons, whether from beryllium or radiation exposure.

The DOE estimates there are 3,000 eligible cases nationwide, including 1,200 with cancer. It will cost $360 million for the first three years.

"We are moving fast forward to do the right thing for these workers," Energy Secretary Bill Richardson said.

While Congress debates, Lutz copes with the anxiety and depression that often accompany chronic illness. CBD sufferers in Colorado have formed a once-a-month support group at National Jewish, but Lutz sometimes hesitates to go.

It means seeing people tethered to oxygen tanks, people whose beryllium disease has advanced much further than hers.

"The people are good friends and you hate to see them suffer," Lutz says. "The main thing is, not knowing what could happen in the future. Eventually, I might end up in that situation."

Contact Lisa Ryckman at (303) 892-2736 or ryckmanl@RockyMountainNews.com.

August 6, 2000




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